Provider Demographics
NPI:1629138219
Name:GOOD SAMARITAN HEALTHCARE, LLC
Entity Type:Organization
Organization Name:GOOD SAMARITAN HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARETES
Authorized Official - Middle Name:
Authorized Official - Last Name:GODINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:725-333-7121
Mailing Address - Street 1:6825 W RUSSELL RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1888
Mailing Address - Country:US
Mailing Address - Phone:702-896-8400
Mailing Address - Fax:702-791-5600
Practice Address - Street 1:6825 W RUSSELL RD
Practice Address - Street 2:SUITE 170
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1888
Practice Address - Country:US
Practice Address - Phone:702-896-8400
Practice Address - Fax:702-791-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0535225100000X
NV1786225100000X
NVRC6512278P1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary RehabilitationGroup - Multi-Specialty
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV294509Medicare Oscar/Certification